Clinical Investigation
Two-Dimensional Speckle Strain and Dyssynchrony in Single Right Ventricles Versus Normal Right Ventricles

https://doi.org/10.1016/j.echo.2010.03.028Get rights and content

Background

Patients with single–right ventricle (RV) physiology are at increased risk for myocardial dysfunction and mechanical dyssynchrony. Newer echocardiographic modalities may be better able to quantitate right ventricular function in this unique population. The aim of this study was to use two-dimensional speckle analysis of strain and strain rate to quantify systolic function and dyssynchrony in single-RV post-Fontan patients and compare them with values for controls.

Methods

Patients with single RV who underwent Fontan palliation and patients with normal biventricular anatomy were studied. Two-dimensional speckle echocardiography was used to measure strain, strain rate, time to peak, and longitudinal displacement in a 6-segment model of the RV. Independent t tests were used to compare group means. P values < .05 were considered significant.

Results

Thirteen patients were studied in each group. There was no significant difference in age between single-RV patients and controls (6.60 ± 2.07 vs 5.75 ± 1.83 years, respectively). Single-RV strain values were significantly lower in all 6 segments compared with values in controls (basal interventricular septum [IVS], −14.28 ± 7.78% vs −22.00 ± 2.36%; mid IVS, −17.70 ± 4.54% vs −22.99 ± 2.71%; apical IVS, −19.46 ± 4.97% vs −25.42 ± 4.06%; basal RV, −22.40 ± 5.7% vs −41.42 ± 5.42%; mid RV, −21.20 ± 3.21% vs −39.67 ± 6.04%; apical RV, −20.70 ± 4.90% vs −33.68 ± 3.90%). Systolic strain rate and longitudinal displacement were also lower in the free wall and apical IVS in single-RV patients compared with controls. The modified Yu index for strain time to peak was longer in the single-RV patients (43.16 ± 13.63 vs 21.72 ± 7.25 ms).

Conclusion

Significant differences in strain analysis between single-RV patients and patients with biventricular physiology exist at a relatively young age. Future studies are needed to determine the clinical significance of these differences.

Section snippets

Study Population

Patients with single morphologic RV physiology who underwent Fontan or Kawashima palliation were recruited. Patients who had cardiac hospitalizations, cardiac surgery, or cardiac catheterization procedures within the past 3 months were excluded. Patients undergoing long-term pacing were also excluded. This cohort therefore consisted of single-RV patients who were cardiovascularly stable. Age-matched control subjects were recruited and prospectively identified by echocardiography to be normal.

Demographics

Fourteen patients with single RVs who underwent Fontan or Kawashima palliation and 16 age-matched control children, who were clinically stable, were consented for the study. One patient with hypoplastic left-heart syndrome and 3 control patients were excluded because of poor tracking, so this study consisted of 13 patients in each group. Excluded patients did not differ significantly from control patients. There was no significant difference in age or weight between groups (Table 1). Clinic

Discussion

In most instances, right ventricular function is described qualitatively because quantification of the systolic function of the RV is difficult to assess because of its unique geometry.5 Quantification of the RV is especially important in those patients with single-RV physiology because their prognosis is markedly different compared with the general population, and the earlier detection of abnormal right ventricular function may aid in treatment options.4, 15, 16 Strain and strain rate are

Conclusion

In this study, children who underwent Fontan palliation were shown to have decreased strain, strain rate, and longitudinal displacement and increased dyssynchrony of the single RV at a relatively young age. The implications of the increased dyssynchrony remain to be determined, but these results may serve as a platform for longitudinal studies to correlate these findings with clinical symptoms to determine if these echocardiographic findings can predict and eventually aid in managing this

Acknowledgment

We would like to thank Pierre Miller, RDCS, RVT, at GE Healthcare for applications support and Dave Melvin, CRT for illustration formatting.

References (33)

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